Sutureless method of rectosigmoid anastomosis and apparatus therefor



Jan. 6, 1948. 'T. G. YEOMANS 4, SUTURELESS METHOD OF RECTO-SIGMOIDANASTOMOSIS AND APPARATUS THEREFOR Filed NOV. 13, 1945 3 advanced towardeach other by means of the ballheaded, square-bodied tie bolt and itsnut 6.

The cup member I is provided with a round clearance hole I, throughwhich the tie-bolt 5 may pass freely, and a spherically formed ball seat8 is marginally constituted about the hole I.

The cup member 2 is provided with a square clearance hole; I5 throughwhich the square bodied tie bolt 5 is adapted to be passed freely.

Surrounding the square clearance hole I5 and in the lower end of the cupmember 2 is a tapered socket I4, adapted to interchangeably receive bodytubes II, of varying lengths, which are provided at one end with atapered portion I3 which mates with the tapered socket I4 and is adaptedto seat 4 string suture 2|, whipped over the cut edge of the bowel andtied around the tie-bolt.

The cup member 2 is then placed in the distal segment of the rectum withthe body tube I I protruding from the anus, where it is held steady byan assistant.

A purse string suture 22 is then placed in the cut edge of the rectum.The cup member 2 and tube I I' are slipped over the tie bolt 5.

The rectal purse string 22 is then tied around the tie-bolt 5, the twosegments of bowel are the tube I I in the socket I4 of the cup member 2.

The opposed, in-turn, annular flanges 3 and 4 of the respective cupmembers I and 2 have been found satisfactory for the desired clampingpurpose when not less than one quarter inch in width and the inner edgesI3 and I9, as well as the outer edges I6 and H, are best adapted for thepurpose when provided with smoothly rounded corners of approximately onesixty-fourth inch radius.

The square bodied tie-bolt 5 is provided with an integral spherical head20, and the portion 9 directly adjacent the ball is necked down to around section for a short distance in order to permit equal ball andsocket action of the ball in the socket 8 in all directions. Theoppositeend of the tie-bolt 5 is provided with threads Ill adapted toengage the internal threads of the hand nut 5. The total length of thetie-bolt 5 is so related to the total length of the body tube II thatwhen the apparatus is assembled, as shown in Fig, 1, clamping pressuremay be exerted between the opposed faces of the annular flanges 3 and 4.

The hand nut 6 may be provided with coarsely fluted grooves to providemore secure gripping surfaces for the fingers,

While a number of metals may be used in the construction of theapparatus, aluminum has proven very satisfactory for the cup members,the body tube and the hand nuts, on account of its light Weight, whilethe tie-bolt is best made from Steel in order to secure sufflcientstrength in a bolt of small diameter.

The maximum diameters of the cup members I and 2 must not be too small,lest the stoma be too narrow, nor should they be too large to removethrough the anus, unless the sphincter is to be divided and laterrepaired.

One and one-half inches has been determined in use to be a median ofsatisfactory diameters.

The body tube l I must be selected of such length that it will projectsufficiently beyond the anus to be grasped and held against turning bysuitable shaped forceps or pliers, but not enough to be clumsy.

The entire apparatus must have all exterior surfaces smooth and highlypolished, but such finish is not necessary on such concealed surfaces asdo not contact the bowel.

The opposing faces of the flanges 3 and 4 may be perpendicular to thelongitudinal axis as shown in Fig. 2, or they may be disposed angularlywith respect to the longitudinal axis, as shown in Fig. 1, in order tofacilitate their concentric axial alignment.

In practice of my method the operating surgeon, having severed the boweland removed the section containing the neoplasm, places the cup member Iupon the tie-bolt 5 and inserts it into the proximal bowel where it issecured by a purse brought together, with the square portion of tiebolt5 entering and freely engaging the square clearance hole I5 and thethreaded portion extending through and beyond the body tube I I.

With the cup members I and 2 manipulated into positions of approximatealignment, the assistant screws the hand nut down against the projectingend of the body tube I I, which he at the same time restrains from anytendency to turn, by means of shaped jaw forceps, and thereby clamps theinturned bowl walls between the opposing faces of the flanges 3 and l ofthe cup members I and 2.

The-tightening of the nut is continued until the clamped portions ofthebowel walls are sufficiently thinned and compressed so that no bloodis thereafter supplied to the clamped portions between the flanges.

The apparatus and the bowel in its then condition are as shown in Fig.1, with the serous coats in goodcontact outside the clamped area, andunion proceeds at once, occuring first by adherence of the serous coatsin contact within approximately six hours and then extending across themuscular coats.

In due course, union will be entirely efiected and the tissues betweenthe opposed clamping surfaces of the flanges 3 and 4, with all of thatportion within the apparatus, will have become dead and have sloughedoff and separated from the living tissues.

The apparatus may then, in its entirety. be lubricated and removedthrough the anus and, after its removal, the mucous membrane growsacross the united junction and anastomosis of the colon to the lowerrectum has been completed.

The operation is rapidly and safely performed without the use of suturesother than the temporary purse strings, which can be eliminated also bythe use of any satisfactory internal, expanding clamp within the innermargins of the flanges,

The appearance of a section of the rectum after anastomosis, withthickened scar tissue, is shown in section in Fig. 3.

Having thus described my invention, I claim:

1. A clamp for recto-sigmoid anastomosis for temporarily retaining theinturned ends of both sections of a severed bowel and adapted to beinserted and removed through the anus, comprising in combination, anupper cup-shaped clamping member, a lower opposed cooperating cupshapedclamping member, each'of said clamping members being provided withinwardly extending opposed clamping flanges, a hollow body member, a tierod extending through said hollow body member and said clamping members,one end of said tie rod extending beyond the hollow body member andmanually operated means cooperating with said extending: end for drawingsaid clamps tightly together, substantially as and for the purposes setforth.

2. A clamp for recto-sigmoid anastomosi for temporarily retaining theinturned ends of both sections of a severed bowel and adapted to bemember, the opposite end of said tie rod having 10 an external ball andsocket connection with the upper clamping member, and manually operatedmeans cooperating with said extending end for drawing said clampstightly together, substantially as and for the purposes set forth.

THERON GROVER YEQMANS.

REFERENCES CITED The following references are of record in the file ofthis patent:

UNITED STATES PATENTS Name Date Bacon July 18, 1933 OTHER REFERENCES Exparte Brinkerholf, vol. 24, Commissioners Manuscript Decisions, page349.

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